Women in states that ban abortion will still be able to get abortion pills online from overseas

Women in states that ban abortion will still be able to end unwanted pregnancies with abortion pills ordered online from overseas, though the legal situation is murky and carries potential risks.

The Supreme Court on Friday overturned the landmark 1973 Roe v. Wade ruling that protected abortion as a constitutional right across the U.S. — allowing states to impose partial or full bans on the procedure.

At least eight states immediately banned all forms of abortion, including medical abortions using the pill, within hours of the Supreme Court’s decision. Health-care providers who perform abortions, and in some cases people who help patients get the procedure, would face criminal prosecutions and yearslong prison sentences. In Missouri, for example, anyone who performs an abortion faces up to 15 years in prison.

However, the states prohibit the prosecution of women who receive abortions, according to the text of the legislation in the eight states. Many women with unwanted pregnancies who cannot travel out of state for an abortion will likely end their pregnancies alone at home with abortion pills purchased online through international telehealth companies like Aid Access.

“Under certain circumstances, it will be possible for women to get medication abortion from these internet providers and self manage their abortion, so it will provide some access to some people but not enough,” said Dr. Jenn Villavicencio with the American College of Obstetricians and Gynecologists.

“People can, with the right information, safely manage their own abortion in the first trimester,” she said. 

Aid Access is an international telemedicine abortion provider founded by Dutch physician Rebecca Gomperts. Its European doctors provide online consultations and write prescriptions for abortion pills, which are then filled and mailed by a pharmacy in India.

Aid Access told CNBC it will continue mailing pills to women in all U.S. states, including those that banned the procedure. U.S. telehealth providers will be banned from prescribing and sending abortion pills to women in states that outlaw the procedure.

The abortion pill, mifepristone, is approved in the U.S. to end pregnancies before the 10th week of pregnancy. The Food and Drug Administration first approved the medication in 2000, but required women to obtain it in person under a program that monitors certain drugs for safety risks.

Abortion rights advocates fiercely criticized the FDA requirements, arguing that mifepristone had a long and proven track of record as a safe and effective way to end an early pregnancy.

In response to the Covid pandemic last year, the FDA temporarily lifted the requirement that women obtain the pill in person. In December, the drug regulator permanently ended the in-person requirement, which will allow certified pharmacies in the U.S. to fill and send prescriptions by mail.

The pill, or medication abortion, has become increasingly common in the U.S. In, 2020, more than 50% of abortions in the U.S. were with the pill, according to a survey of all known providers by the Guttmacher Institute.

Aiken and Aid Access published a study in The Lancet in February that examined the records of nearly 2,800 people in the U.S. who used abortion pills prescribed by the group from March 2018 to 2019. About 96% of the patients reported that they successfully ended their pregnancy without surgical intervention. One percent of patients reported a serious side effect where they needed treatment, including blood transfusion and intravenous antibiotics. No deaths were reported.

Aid Access offers financial assistance to patients with a sliding scale that generally ranges from $55 to $150 depending on the patient’s circumstances, according to Robin Tucker, a nurse practitioner works for the group in Maine, Maryland and Virginia. Delivery from pharmacy in India to the U.S. generally takes one to three weeks, though Aid Access is looking at finding a pharmacy in Mexico or Canada to shorten delivery time, Tucker said.

It is illegal in most cases for U.S. citizens to import drugs for personal use from outside the country, though the individuals usually aren’t targeted for prosecution. The FDA issued a cease and desist letter to Aid Access in 2019, though the organization has continued mailing pills.

Biden, the Justice Department, and the Health and Human Services Department on Friday indicated that they will take action to expand access to the pill within the U.S., though it’s not yet clear how.

In April, a women in South Texas was charged with murder after allegedly having a self-induced abortion, although state law exempts women from prosecution for having abortions. A hospital reported her to the country sheriff’s department. District Attorney Gocha Allen Ramirez ultimately dismissed the indictment, saying it is clear that she “cannot and should not be prosecuted for the allegation against her.”

The abortion pill is about 97% effective at ending pregnancy though it’s most successful when taken at 49 days or earlier, according to a report by the American College of Obstetricians and Gynecologists. Common side effects include nausea, vomiting, diarrhea, weakness, headache, dizziness, fevers and chills.

Women take one mifepristone pill orally and then four misoprostol pills one to two days later. The patient places two misoprostol pills between the cheek and gum on one side of the mouth and the other two pills on the other side of the mouth and waits for them to dissolve. Mifepristone blocks the hormone progesterone, which allows the lining of the uterus to break down and prevents the pregnancy from continuing. Misoprostol causes contractions that empty the uterus, basically inducing a miscarriage.

Serious complications are rare but they can include an incomplete abortion, blood clots in the uterus, bleeding too much, infection and allergic reactions, according to Planned Parenthood. In the event of an incomplete abortion, the tissue left in the uterus might need to be removed through surgical abortion.

Women who take the abortion pill should have access to a phone and transportation to a medical facility in the event serious complications do occur, according to the National Abortion Federation. However, it’s unclear how much access women in banned states will have to health-care if they are one of the rare patients who has complications from the pill.

Robin Marty, the operations director of West Alabama Women’s Center, said in some cases women who have had complications from the pill or thought they were having complications have been refused care at emergency rooms at some hospitals in Alabama.

“Anyone who is having any sort of pregnancy complication needs to understand that there is nothing that they need to say to a doctor when they go in other than ‘I’m pregnant – I’m scared and I think I’m having a miscarriage,” Marty said. “That is all the information that they need to provide. Doctors owe them an examination. Emergency rooms owe them medical care.”

Some people should not have medication abortions. They include women with ectopic pregnancies because the pill does not terminate these pregnancies. Women with blood clotting disorders, adrenal failure, inherited porphyria, those on long-term steroid therapy or who have a history of allergic reactions to the pill also should not take it, according to the FDA. Women with IUDs in place should have them removed before having a medication abortion.